MEDICARE: TRACY MICHELLE JAMES PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P13384	NC

General Provider Information

NPI Number	:	1417227042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY MICHELLE JAMES PT

Provider Business Mailing Address
First Line	:	PO BOX 601791
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1791
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3515 W MARKET ST STE 130
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-4441
Country	:	US
Telephone Number	:	336-660-5390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	11/17/2021

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